Apply for Assistance

Please submit inquiries here

Please be aware that DV LEAP assists with legal appeals of unjust rulings in family violence cases. We do not provide legal representation for individuals before there is a final judgment. Residents of the District of Columbia, Maryland and Virginia may be eligible for certain limited additional assistance.

Please fill out the form below so we can assess your eligibility. If you are seeking help in an appeal, we will also need to review the written court transcripts to determine if your case meets the necessary criteria. We cannot guarantee we will be able to help you.

Please note that filling out this application does not create an attorney-client relationship and any information that you provide on this intake is not subject to client confidentiality protections.

Name: *

Date:

Address:

State/County where case is being litigated:

Email: * please make sure your email is correct

Your Phone:

Applicants Date of Birth (Month/Day/Year)

Attorney (if represented):

Attorney's Firm:

Attorney's Office Phone:

Attorney's Email:

How did you find out about DV LEAP?

Opposing Party (full name):

Opposing Counsel:

Opposing Party Date of Birth (Month/Day/Year):

Issue(s) you would like assistance with (brief description): *

Specific assistance you think DV LEAP can provide you:

In order to better serve our clients and expand our reach to survivors, DV LEAP asks the following two questions about income and race/ethnicity. This demographic information is confidential and will NOT affect your eligibility for an appeal.

Please select the average number of people living in your household over the past 12 months, and indicate whether your annual gross (before taxes) income was above or below the corresponding amount listed below *

What is your race/ethnicity? *

Has there been a final court order in your case? If yes, what was the date?

Are there any upcoming legal deadlines?

We often collaborate with other non-profit organizations, have you reached out to any other organization for help with this appeal? *

Thank you! Your submission has been received!

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